New Patient, Basic BEFORE Colonoscopy Visit: $455
If registration and forms are completed online prior to visit, you pay $355
New or Established Patients,
Basic BEFORE Colonoscopy Visit, Patients WITH Insurance
This service is ideal for patients who overall are healthy AND feel healthy and would like to have a screening colonoscopy for their age (e.g. 50 and above), or when there is concern about colon cancer because of family history or other risk factors or symptoms (could be under age 50).
Quoting a FEE for a patient with insurance is a lot more complex, simply because there are many factors to consider. In many instances Out-of- Network (OON) may be as beneficial or more beneficial as In-Network (INN). Please review the following information, which we believe would assist you in deciding how best to proceed.
Please remember that you can always request a “BEFORE Colonoscopy Visit” at a “cash rate” of $235 to meet with the physician, go over many details, and decide what is the best approach. You can request this service under our LA Integrative Gastroenterology, Inc. Our Contact Info.
- The following information relates ONLY to SCREENING COLONOSCOPY, which is part of our “Technical Services.”
- Insurance industry and coverage criteria can be very complex and confusing. In our experience, any quote about a “patient’s portion” of the cost is an estimate, or speculation, until the actual CLAIM is examined by the carrier.
- As a general experience, EPO, POS, Covered CA, and Affordable Care Act plans do not pay, or adequately pay, for our services and we do not accept these insurances. We invite you to inquire about our “cash rate” for colonoscopy, endoscopy, or both together.
- Each insurance now has several/many “insurance products,” which are different insurance packages. Some of these packages may cover our services and some may not. Therefore, saying, for example, “I have Anthem Blue Cross” does not mean that we are in network and/or we get paid for our services.
- For patients who do have traditional PPO insurance, the pre-colonoscopy visit (and/or the colonoscopy) may be covered depending upon your insurance, your benefits, and whether we are in network. See below.
- If you are covered under these PPO plans: Anthem Blue Cross, Blue Shield, Health Net, and Cigna, you can call the carrier to see what coverage you have for colonoscopy and the visit before that. In contacting the carrier, please have the following information handy:
- This Tax ID: 20-4781781 (Rahbar Medical Group, Inc)
- CPT code for the visit: 99203 through 99205
- CPT code for colonoscopy (45378; 45380; 45385; 45381) or a combination of these, which depends on the extent and complexity of your procedure(s).
- Having said the above, you may still not get a 100% clear response from your insurance company, partly because they also have to examine the actual CLAIM.
- In instances that you have been evaluated by our doctor, we can give you better estimates of the cost. Respectfully, we generally cannot give quotes on the phone (when you plan to use your insurance), based on the many factors described above.
- IMPORTANT: As a reminder, do not forget about your Out-of- Network (OON) benefits. Many times, your insurance OON benefits have better coverage and help to save you money. Many vendors, including our office, are willing to work with your OON coverage. In these instances, we can give you an estimated cost, and payment options – after you have been evaluated by our physician.
- We are currently NOT in network with ANY INSURANCE COMPANY. These insurances have several insurance packages and some of them may have reasonable out-of network (OON) coverage. If you have been evaluated by our physician, we can give you an estimated cost, and payment options. The maximum you pay for a BEFORE Colonoscopy Visit with our doctor is $235.
Important Notice About CASE COMPLEXITY:
If you are a patient with medical conditions that may increase your overall risk of the procedure, please let us know in advance. The above “BEFORE Colonoscopy Visit” may not be sufficient to evaluate patients with complex medical problems. Examples of medical complexity problems are shown below. These patients would require more comprehensive evaluation prior to their procedures to assess benefits and risks and implement any precautions.
Examples of case complexity conditions are as follows:
- Diabetes controlled with insulin
- Seizure disorder
- Cardiac disease
- History of heart attack (myocardial infarction)
- Using blood thinners of any sort (other than preventive use of aspirin)
- Neurological disorder such as history of stroke
- Generally speaking, above age 65
- Lung disease, COPD, active asthma, etc.
- Anxiety and panic disorder, or other psychiatric disorder
- Mentally disadvantaged
- On multiple medications (more than two)
- Pregnancy or planning for one
- Having active symptoms, such as diarrhea, weight loss, difficulty swallowing, abdominal pain, etc.
- Active infection
- More …
For a more comprehensive list of complex conditions, which still may not be all inclusive, please see the attachment (PDF).
Patients with any of the above conditions need to be formally evaluated under our Comprehensive Consultation Services before proceeding with any outpatient procedure that requires anesthesia or has a remote inherent risk.
A visit before colonoscopy, or endoscopy, is highly recommended for many reasons:
- It provides an opportunity for patient and doctor to meet and make sure they are comfortable with each other and all questions can be answered.
- It provides a chance to discuss benefits, remote risks, and alternative approaches, if desired.
- It gives a chance to review any comorbid conditions, such as diabetes, a heart murmur, or seizure disorder that need to be addressed before the procedure or during the preparation.
- The doctor will review preparation options that may be more appealing to the patient and timing of the procedure. As such, the preparation can be customized. For example, patients with chronic constipation or who are taking certain drugs may need more than one day for preparation.
- The staff will go over the steps before colonoscopy and give instructions and logistics about facility, etc.
- The fee for the procedure and payment options will be discussed during this visit.
- Our procedures (colonoscopy/endoscopy) are performed at LA Peer Surgical Center in Beverly Hills. For more info, please visit…https://lapeerhealth.com/
COMPONENTS OF COSTS FOR COLONOSCOPY AND/OR ENDOSCOPY:
- Facility Fee
- Doctor’s Fee for the Procedure
Please notice, if you are planning to use your insurance, we generally can only provide estimated “patient portion” after you have had a chance to visit the doctor.
After REVIEWING ABOVE, if you are still simply interested in a QUOTE, please provide us with the following information:
- Your name and date of birth.
- Referring doctor, if any.
- Are you currently under the care of a primary care physician?
- Are you covered under PPO insurance?
- If yes, please provide details.
- Do you plan to submit a superbill to insurance for possible reimbursement?
- Do you have any of the above “Case Complexity” conditions?
We generally respond in five business days.